Whether it's called 'dry drunk' or 'white knuckle sobriety,' it's that stage in recovery when we realize that 'putting the plug in the jug' isn't enough. The next step is taking responsibility for the emotional immaturity that fuels our addictive personality and has a tremendous impact on ourselves and others.

In 12 Smart Things to Do When the Booze and Drugs Are Gone, Allen Berger, Ph.D., draws on the teachings of Bill W. and psychotherapy pioneers to offer twelve hallmarks of emotional sobriety that, when practiced, give people the confidence to be accountable for their behavior, ask for what they want and need, and grow and develop a deeper trust in the process of life. These 'smart things' include:

It is in these practices that we find release from what Bill W. described as an 'absolute dependency' on people or circumstances, and develop the tools to find prestige, security, and belonging within.

Are you sabotaging your own recovery?

To grow in recovery, we must grow up emotionally. This means getting honest with ourselves and facing up to the self-defeating thoughts and actions that put our sobriety at risk. Although there are as many ways to mess up recovery as there are alcoholics and addicts, some general themes exist, which include:

• confusing self-concern with selfishness
• not making amends
• using the program to try to become perfect
• not getting help for relationship troubles
• believing that life should be easy

In simple, down-to-earth language, Allen Berger explores the twelve most commonly confronted beliefs and attitudes that can sabotage recovery. He then provides tools for working through these problems in daily life. This useful guide offers fresh perspectives on how the process of change begins with basic self-awareness and a commitment to working a daily program.

"New, scientifically-based approaches that recognize the biological basis of addiction have brought major advances in the treatment of addiction. Dr. Urschel is at the forefront of this treatment paradigm."
Dr. Larry Hanselka, Psychologist

The Proven Scientific Approach to Conquering Addiction and Defeating the Disease

Healing the Addicted Brain is a breakthrough work that focuses on treating drug and alcohol addiction as a biological disease—based on the Recovery Science program that has helped thousands of patients defeat their addictions over the past 10 years. It combines the best behavioral addiction treatments with the latest scientific research into brain functions, providing tools and strategies designed to overcome the biological factors that cause addictive behavior along with proven treatments and medications.

Using this scientific approach, you will learn to conquer the physical factors that keep people tied to drug and alcohol addiction. The proven fact is addiction is not a moral failing or an issue of not having enough willpower. It is a disease of the brain that can and must be treated like other chronic medical illnesses —such as diabetes, hypertension, or asthma—in order to defeat the disease.

This revolutionary program can triple the success rate of patients, from 20-30% to 90%

There Is Hope.

Melanie Solomon's book compares and contrasts many different self-help programs so the client can better choose which one best suits his or her needs, as well as contact information for licensed professionals and treatment facilities throughout the U.S. and abroad. "This book is ideal for any addiction professional's waiting room, treatment process, or as an integral part of the client's continuing care plan." (NAADAC-The Association for Addiction Professionals).

"AA-Not the Only Way fills an important niche in the recovery literature. It offers a compact but wide-ranging guide to addiction support and treatment options. The author's recovery story will also be an inspiration to those who find themselves battling a one-size-fits-all system that is supposed to be helping them." (Dr. Tom Horvath, President of SMART Recovery).

Author: Melanie Solomon
Paperback: 106 pages
Company: Capalo Press (2008-11-28)
ISBN: 0976247992
List Price: $24.95
Amazon Price: $15.92
Used Price: $15.92

Disaster recovery is often unplanned for in the emergency management life cycle. Yet recovery is the key stage where funds, programs, professional expertise, and volunteer efforts are applied to affected cities, states, and regions to get them up and running again. Providing a unique perspective on a highly focused area, Disaster Recovery is the first core text that tackles the myriad recovery issues faced by federal, state, and local emergency managers, public officials, and voluntary organizations in a long-term disaster recovery situation.

The book takes a holistic approach, integrating the various challenges of recovery such as housing, the infrastructure, and workplaces. Disaster Recovery emphasizes three key themes by integrating vulnerable populations into each chapter, stressing the importance of tying mitigation measures into every aspect of recovery, and encouraging rebuilding in environmentally sustainable ways. Coverage includes topics such as recovery planning, housing, debris management, business and private sector recovery, public/governmental recovery and operations, historical and cultural preservation, environmental recovery, social and psychological recovery and services, voluntary non-governmental organizations (NGOs), federal assistance programs, grant-writing, and donations management.

Pedagogical tools to clarify concepts

Each chapter features pedagogy to encourage comprehension and retention, including key terms, learning objectives, highlighted practical applications, review questions, a summary, and references. Numerous classic and recent case studies ensure concepts are fully explained and illustrated. In addition, PowerPoint® slides are also available for adopters. Designed for professional and classroom use, this volume thoroughly covers the disaster recovery process, offering vital insight into the evolving field of emergency management.

"Just when you thought recovery couldn't get any harder, life on life's terms happens, and sometimes that means someone perpetrating violence on you or your home."

These words from the introduction of Jennifer Storm's newest book encapsulate a very real problem facing thousands in recovery today. Being victimized by crime can be a life-altering, traumatic experience—one that can potentially throw a person off the course of recovery and back into the throes of addiction.

Focus is on rebuilding one's life after the devastation of a crime or trauma, while preventing relapse and promoting healing and self-awareness. Through guided exercises, journaling, recovery reminders, and other helpful tools, readers will be empowered to move through their victimization with grace and strength.

Picking up the Pieces without Picking Up offers a caring voice and expert guidance for those struggling with victimization and addiction, and also serves as a valuable resource for professionals in the treatment field, the criminal justice system, and the counseling arena.  

'Today I choose the light.'

Jennifer Storm's first memoir, Blackout Girl: Growing Up and Drying Out in America, tells the haunting story of her downward spiral into addiction that began when she was raped at twelve years old. She remained on a dangerous, self-destructive path for ten dark years, until one day she awoke in the hospital after attempting to commit suicide and realized she needed help.

Now, Leave the Light On: A Memoir of Recovery and Self-Discovery offers a deeper look into Jennifer's inspiring story of survival and transformation. With fearless honesty, she chronicles her journey as she embarked upon a new life in recovery, finally facing her traumatic past, her buried emotions, and her long-hidden truth about her sexuality. A unique blend of addiction recovery and coming-out story, this book provides a positive, encouraging example for those who are facing similar adversities. Jennifer holds nothing back in this courageous and insightful memoir.

Featuring prayers for the everyday challenges of modern life, as well as ageless prayers and contemplative readings inspired by traditional devotions. Guide Me in My Recovery contains words of wisdom and inspiration that can be used by anyone, but especially by those in twelve-step recovery seeking to enrich and expand their conscious contact with their Higher Power. Featuring original prayers by the author, John Farrell, Ph.D., Regimental Chaplain and Director of Campus Ministries at SUNY Maritime College, as well as prayers synthesized from common prayers and devotional writings, this book is intended to aid and inspire spiritual seekers.

Keywords: 12 step, recovery, chemical dependency, addiction, compulsive behavior, drug use.

Author: Belleruth Naparstek
Audio Cassette:
Company: Health Journeys (1997-01-01)
ISBN: 1881405044
List Price: $12.98
Amazon Price: $7.95

Twelve Jewish Steps to Recovery explains how the Twelve Steps of Alcoholics Anonymous is relevant for Jewish people. Many Jewish people see the Twelve Steps as "Christian" and have difficulty relating to the Steps as Jews. The authors present the Twelve Steps in a Jewish context.

In a spiritually supportive way, Rabbi Olitzky and Dr. Copans resolve questions such as: Why are Jews uncomfortable with the Twelve Steps? How does the Jewish understanding of the material differ from the Christian understanding of it? Which Jewish sources explore the concepts of recovery and renewal? They present a Jewish perspective on the Twelve Steps and offer consolation, inspiration, and motivation for recovery through drawing on traditional Jewish sources and quoting from what recovering Jewish people say about their experiences.

Artist Maty Grünberg's illustrations of the gates of the Old City of Jerusalem open each chapter of Twelve Jewish Steps to Recovery as the reader is welcomed into another stage of a Jewish Twelve Steps experience. These illustrations were selected to emphasize the relationship between heavenly and earthly in all our lives through the prism of Jerusalem.

Author: Kerry M. Olitzky, Stuart A. Copans
Paperback: 136 pages Bargain Price
Company: Jewish Lights Publishing (1991-09)
List Price: $15.99
Amazon Price: $8.99
Used Price: $5.74

Hope and Healing for Children
Hurt by Addiction in the Family

'I have spent my adult life in the company of children who have been my teachers. We got to know each other because someone in each child's life was addicted to alcohol or other drugs.

For thirty years I have had a front-row seat in group watching, learning, and helping these youngest victims of addicted families, children who live with a legacy that can break hearts and destroy souls--one they certainly did not choose. They arrive carrying secrets, confusion, and pain. But almost all find their voice. These children can and do heal.'

Understanding Addiction and Recovery Through a Child's Eyes shares the poignant and profound healing journeys of children who have found their voice and reclaimed their sense of self-worth. Each story reminds us that children have a unique way of viewing the world and shows how, with help, they can build upon strengths and deepen their resilience in spite of living in the shadow of addiction. In addition to the life-affirming stories, esteemed children's counselor Jerry Moe reveals how the healing process transcends the children and has a dramatic impact on the entire family system--especially their parents, giving them a new, deeper commitment to break the multigenerational legacy of addiction.

It was once taken for granted that peer-assisted groups such as Alcoholics Anonymous had no “real” value in recovery from addiction. More recently, evidence-based medicine is recognizing a spiritual component in healing—especially when it comes to addiction. The newest edition of Recent Developments in Alcoholism reflects this change by focusing on the 12-step model of recovery as well as mindfulness meditation and other spiritually oriented activity. More than thirty contributors bring together historical background, research findings, and clinical wisdom to analyze the compatibility of professional treatment and nonprofessional support, day-to-day concepts of relapse prevention, the value of community building in recovery, and much more.

Among the topics covered: (1) How and why 12-step groups work. (2) The impact of the spiritual on mainstream treatment. (3) The impact of AA on other nonprofessional recovery programs. (4) AA outcomes for special populations. (5) Facilitating involvement in 12-step programs. (6) Methods for measuring religiousness and spirituality in alcohol research.

Whether one is referring clients to 12-step programs or seeking to better understand the process, this is a unique resource for clinicians and social workers. Developmental psychologists, too, will find Volume 18—Research on Alcoholics Anonymous and Spirituality in Addiction Recovery a worthy successor to the series.

It's for all people who would gain insight-- and strength to heal--from Jewish tradition.
* All people who are in trouble with alcohol, drugs, or other addictions--food, gambling, and sex
* Anyone seeking an understanding of the Twelve Steps from a Jewish perspective--regardless of religious background or affiliation
* Alcoholics and addicts in recovery
* Codependents
* Adult children of alcoholics
* Specialists in recovery and treatment

"A powerful tool for spiritual transformation.... Guides all Jews seeking a Twelve-Step exodus from their personal enslavements to the promised land of freedom."
--Rabbi Rami Shapiro, author, Recovery--The Sacred Art: The Twelve Steps as Spiritual Practice

"With honesty, compassion and hope ... weaves together the wisdom of AA Twelve Steps and Jewish teaching into a strong cord that ably pulls the reader out of the rut of compulsive behavior toward the freedom of responsible living."
--Rabbi Elie Kaplan Spitz, author, Healing from Despair: Choosing Wholeness in a Broken World

"A `must have' for any recovering person's library. Will help countless people begin the journey to a life of meaning and purpose, contentment and serenity. Our residents will all receive a copy as soon as they enter our doors."
--Martha J. Meehan, executive director, Jewish Recovery Houses, Inc.

"Should be read by all people who are seeking meaning, purpose and a relevant spiritual path, whether they are officially recovering or not. The teachings reflect the essence of Jewish wisdom and are applicable to daily life. This book will be required reading for all residents of Beit T'Shuvah."
--Harriet Rossetto, LCSW, founder and CEO, Beit T'Shuvah

Author: Kerry M. Olitzky, Stuart A. Copans
Paperback: 113 pages
Company: Jewish Lights Publishing (2009-10)
ISBN: 1580234097
List Price: $16.99
Amazon Price: $10.35
Used Price: $9.75

Being a mom is one of the hardest and most important jobs a woman can have. Being a mom in recovery is even more challenging.

In Moms to Moms, counselor Barbara Joy shares the stories, advice, and inspiration from more than 60 mothers in recovery from across the United States who have struggled with addiction. These are women of all ages, races, and religious affiliations who candidly share their experiences: the challenges of being a mom in recovery, the values they want to teach their children, and their fears, struggles, and accomplishments.

This is a book that offers help and hope to busy, stressed out moms in recovery; a book they can turn to again and again to find inspiration, comfort, and advice. Joy offers evaluation tools and strategies for positive parenting, journaling activities for reflections, and affirmations designed to relieve stress and reinforce positive behavior.

"I knew about drunk, but did not know anything about living sober. I hadn’t really been sober for fifteen years. It wasn’t enough that I stopped drinking. I had to learn how to live."

The journey from alcoholic insanity to sobriety—and the pivotal role of Alcoholics Anonymous (AA) in navigating that transition—is the focus of Last Call. Using powerful first-person narratives like the one above (composites of many anonymous speakers), psychotherapist Jack H. Hedblom provides compelling insights into the minds and hearts of addicted drinkers, from bizarre behavior and denial to the moment of "hitting bottom" and seeking change.

Hedblom covers the process of getting sober, from diagnosis to detox to sobriety. He focuses on the challenge of learning to live without drinking—a long-term goal, Hedblom asserts, that is best achieved by regular participation in AA.

Hedblom’s vivid descriptions reveal AA meetings as gatherings of fellowship, compassion, tears, and laughter. In relating the history of the organization, he describes the role of sponsors, elaborates on the Twelve Steps and the Promises, emphasizes the importance of spiritual development in recovery, and refutes the common misconceptions that equate spirituality with organized religion.

Through the stories of people who have escaped the tyranny of alcoholism with the help of AA, Hedblom shows that the road to recovery is a journey of self-discovery, change, and hope.

These are people who are alternately amazed, appalled, delighted, depressed, illuminated, disturbed, or simply thrown by their first days, weeks, and months of sobriety. Kettelhack explores the challenges all seem to face: learning to break through loneliness, isolation, and fear; finding ways to deal with anger, depression, and resentment; and learning how to deal with a new and sometimes overwhelming happiness.

Guy Kettelhack has written seven books on recovery. He is completing a Master's degree in psychoanalysis, and is an analyst-in-training at the Boston and New York Centers for Modern Psychoanalytic Studies. A graduate of Middlebury College, Kettelhack has also done graduate work in English literature at Bread Loaf School of English at Oxford University. He lives in New York City.

Author: Guy Kettelhack
Paperback: 142 pages
Company: Hazelden (1998-09-30) (1998-09-30)
ISBN: 1568382308
List Price: $12.95
Amazon Price: $6.01
Used Price: $1.51

Living Sober Sucks offers a different path that breaks the stereotype of the 12-step system. It is an inspiring, real life story, not like any other story you've heard before. Living Sober Sucks is entertaining, funny, sad, controversial and thought provoking. Written using very raw and straight forward terms. No holds barred when talking to the alcoholic. Reality is reflected on every page. Whether you're a full blown raging alcoholic or just feel like alcohol is complicating your life and relationships, you will get something out of this book. It is an uncomplicated plan for the average person. Everyone knows someone who needs to read Living Sober Sucks.

Living Sober Sucks is not an anti-alcohol book, it is a descriptive work that offers strategies, techniques and ideas to stop letting alcohol run someone's total existence. All drunks are not jerks riddled with flaws, defects and despicable characteristics. Many are genuinely good people who over indulge and make poor choices while under the influence. They do not need the program to break them down, force them into a belief system or rebuild them into something they are not. What they need is to have other viable alternatives, to believe in themselves and their own willpower.

It is true that many problem drinkers have a physical dependency and psychological addiction to alcohol, but it is still a choice to drink. Sparked by the popularity of LivingSoberSucks.com this philosophy is detailed in Living Sober Sucks. It gives readers realistic and tangible examples of how to eliminate guilt, rebuild self-esteem, discover creativity and possibly repair damaged relationships. The reader is shown ways to rid their life of chaos, unnecessary drama and avert the stigma of being titled a recovering alcoholic. They will discover how to feel like and be treated like a normal person. They are shown how to save money and amass a small fortune. Learn to enjoy a fun, fully engaged normal life - sober.

This narrative nonfiction is part memoir but mostly descriptive ideas to help you maintain and enjoy sobriety. Questions are raised on how you can become sober and realistic answers are given.

Author: Mark A. Tuschel
Paperback: 230 pages
Company: CW Media, Inc. (2009-11-18)
ISBN: 098427300X
List Price: $12.95
Amazon Price: $12.95
Used Price: $11.66

Book 1 in The Vitamin Cure Series
Most people_s diets are woefully inadequate for providing proper nutrition. Even good diets fail to deliver sufficient levels of nutrients. The Vitamin Cure book series highlights the safe and clinically effective use of vitamin supplements for a variety of illnesses. Research continues to prove the immense value of vitamins for maintaining health and fighting disease. The Vitamin Cure books, written by authors who are recognized experts in their field, offer authoritative, up-to-date, and practical information on taking vitamins for particular health problems.

The Vitamin Cure for Alcoholism can help those who suffer from alcohol addiction, their friends and loved ones, and those in the relevant helping professions. Its central message is that alcoholism is primarily a metabolic disease that should be treated nutritionally first. The person called an _alcoholic_ suffers from nutrient deficiency, especially vitamin B3, and seeks relief by consuming alcohol. Megavitamin therapy is not only more effective than drugs or counseling, it is cheaper and safer. Behavioral and psychological treatment approaches have lacked long-term success, largely because they pay little attention to the nutritional needs of alcoholics. In fact, Bill W., the man who cofounded Alcoholics Anonymous (AA), promoted the concept of megavitamin therapy.

Nutrition can cure alcohol addiction.


Author: Abram Hoffer, Andrew W. Saul
Paperback: 144 pages
Company: Basic Health Publications (2009-05-15)
ISBN: 159120254X
List Price: $14.95
Amazon Price: $10.04
Used Price: $12.02

Pain Recovery for the Family provides a solution-oriented approach for family members to maintain a healthy life balance while providing support to someone with chronic pain.

Chronic pain is a life-changing condition, and not just for the person in pain; chronic pain afflicts the whole family. Even a well-functioning family is likely to be thrown out of balance when one of its members has chronic pain. Family members commonly report experiencing feelings of guilt, helplessness, depression, anxiety, and even resentment. Yet their suffering is often overlooked. In many cases, the pain sufferer's problematic use of painkillers or other substances prescribed for pain management adds to the family's confusion and distress.

Includes self-assessments and writing exercises designed to address the many facets of chronic pain and addiction and their physical, mental, emotional, and spiritual effects on the family.

Disaster recovery is often unplanned for in the emergency management life cycle. Yet recovery is the key stage where funds, programs, professional expertise, and volunteer efforts are applied to affected cities, states, and regions to get them up and running again. Providing a unique perspective on a highly focused area, Disaster Recovery is the first core text that tackles the myriad recovery issues faced by federal, state, and local emergency managers, public officials, and voluntary organizations in a long-term disaster recovery situation.

The book takes a holistic approach, integrating the various challenges of recovery such as housing, the infrastructure, and workplaces. Disaster Recovery emphasizes three key themes by integrating vulnerable populations into each chapter, stressing the importance of tying mitigation measures into every aspect of recovery, and encouraging rebuilding in environmentally sustainable ways. Coverage includes topics such as recovery planning, housing, debris management, business and private sector recovery, public/governmental recovery and operations, historical and cultural preservation, environmental recovery, social and psychological recovery and services, voluntary non-governmental organizations (NGOs), federal assistance programs, grant-writing, and donations management.

Pedagogical tools to clarify concepts

Each chapter features pedagogy to encourage comprehension and retention, including key terms, learning objectives, highlighted practical applications, review questions, a summary, and references. Numerous classic and recent case studies ensure concepts are fully explained and illustrated. In addition, PowerPoint® slides are also available for adopters. Designed for professional and classroom use, this volume thoroughly covers the disaster recovery process, offering vital insight into the evolving field of emergency management.

Alcohol Clin Exp Res. 2012 Feb 6;
Dawson DA, Goldstein RB, Ruan WJ, Grant BF

BACKGROUND: Correlates of recovery from alcohol dependence have been identified through a variety of study designs characterized by different strengths and limitations. The goal of this study was to compare correlates of recovery based on a 3-year prospective design with those based on cross-sectional analyses of data from the same source. METHODS: Data from the 2001 to 2002 Wave 1 and 2004 to 2005 Wave 2 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) were used to examine baseline characteristics associated with Wave 2 recovery from alcohol dependence, among those who classified with past-year DSM-IV alcohol dependence at Wave 1 (n = 1,172). RESULTS: Abstinent recovery was significantly associated with Black/Asian/Hispanic race/ethnicity, children

Addict Biol. 2012 Jan 20;
Stavro K, Pelletier J, Potvin S

The cognitive repercussions of alcohol dependence are well documented. However, the literature remains somewhat ambiguous with respect to which distinct cognitive functions are more susceptible to impairment in alcoholism and to how duration of abstinence affects cognitive recovery. Some theories claim alcohol negatively affects specific cognitive functions, while others assert that deficits are more diffuse in nature. This is the first meta-analysis to examine cognition in alcohol abuse/dependence and the duration of abstinence necessary to achieve cognitive recovery. A literature search yielded 62 studies that assessed cognitive dysfunction among alcoholics. Effect size estimates were calculated using the Comprehensive Meta-Analysis V2, for the following 12 cognitive domains: intelligence quotient, verbal fluency/language, speed of processing, working memory, attention, problem solving/executive functions, inhibition/impulsivity, verbal learning, verbal memory, visual learning, visual memory and visuospatial abilities. Within these 12 domains, three effect size estimates were calculated based on abstinence duration. The three groups were partitioned into short- (1 year) term abstinence. Findings revealed moderate impairment across 11 cognitive domains during short-term abstinence, with moderate impairment across 10 domains during intermediate term abstinence. Small effect size estimates were found for long-term abstinence. These results suggest significant impairment across multiple cognitive functions remains stable during the first year of abstinence from alcohol. Generally, dysfunction abates by 1 year of sobriety. These findings support the diffuse brain hypothesis and suggest that cognitive dysfunction may linger for up to an average of 1 year post-detoxification from alcohol.

Nihon Arukoru Yakubutsu Igakkai Zasshi. 2011 Oct; 46(5): 454-68; discussion 469
Komoto Y, Hashimoto N, Ikegami Y

It is important to evaluate and classify individual features of patients to select an appropriate treatment for alcoholism. In this study, we classified alcoholism types according to strength/weakness of autism features and investigated how these features were associated with onset, course, and especially continuation of abstinence.The subjects were 102 man outpatients diagnosed with alcoholism. The investigations were made on 3 areas: 1. Basic background including age, family and occupational information, 2. Medical variables including the number of years since the first visit, with/without juvenile onset, psychiatric complications, hospital admission history, self-help group participation, and the longest abstinence period, and 3. Autism-spectrum Quotient (AQ) scores. The AQ test is a self-administered test of autism features on a maximum scale of 50 points, based on the concept of "autism spectrum".The mean (standard deviation) of AQ scores of 102 subjects was 22.6 (7.18) with normal distribution. 78 subjects who had been followed-up for more than 2 years were classified into the low score (0-15) group of 11 subjects, the average score (16-29) group of 51 subjects, and the high score (30-50) group of 16 subjects, according to their AQ scores. No significant difference was observed in terms of patients' background and medical variables, but the number of subjects with stable abstinence (more than 2 years) was higher in the high score group compared to the average and low score groups (p = 0.0208).At least for men, it was presumed that continuation of alcohol abstinence was more difficult in the average score group (general type) and the low score group (over-empathy type) compared to the high score group (autism type) (odds ratio: 5.76); treatment approaches should be managed appropriately for these 3 types. It was also shown that the AQ test was a useful indicator for abstinence prognosis.

Curr Drug Abuse Rev. 2011 Dec; 4(4): 250-60
Haber JR, Koenig LB, Jacob T

A review of the literature on the relationships between alcoholism, personality, and religion identified patterns that may help explain the inverse association between alcoholism and religion/spirituality (R/S). Personality plays a central role in two etiological models of alcoholism. The personality traits of high behavioral undercontrol (low Agreeableness and low Conscientiousness) and high negative affect (high Neuroticism) are both significantly related to higher alcohol use. Religiosity is also correlated with these traits, but in the opposite direction (e.g., with low behavioral undercontrol and low negative affect). Thus, the personality profiles associated with alcoholism and religion are the inverse of one another. In addition, evidence suggests that R/S moderates genetic variation on both Neuroticism and Disinhibition (part of behavioral undercontrol). Implications are discussed in terms of competing explanatory models: a basic research model which argues for genetically-determined stability in personality and alcoholism risk, and a clinical treatment model which argues for the primacy of environmental interventions in treatment and the possibility of personality change as a pathway to recovery.

J Subst Abuse Treat. 2011 Nov 22;
Steenbergh TA, Runyan JD, Daugherty DA, Winger JG

Members of the National Association of Alcoholism and Drug Abuse Counselors (n = 231) participated in a survey concerning their view of the role of personal responsibility in addictions treatment and its relation to their exposure to neuroscience (i.e., the amount to which members considered themselves familiar with current neuroscience research). We used the two-dimensional model of responsibility (Responsible/not responsible for development × Responsible/not responsible for recovery) proposed by P. Brickman et al. (1982) to guide our assessment of responsibility, thus inquiring about counselors' views of clients' responsibility for both the development of a substance-related addiction and its resolution. Findings suggest that counselors rate biological factors as most influential in the development of an addiction and assign clients less personal responsibility for the development of an addiction than for recovery from an addiction. Counselors' level of neuroscience exposure was negatively correlated with their ratings of client responsibility for the development of an addiction but positively correlated to ratings of client responsibility for recovery. This suggests that counselors are integrating neuroscientific findings with what is learned from other modes of enquiry in a way that diminishes the view that clients are responsible for addiction development but accentuates the view that clients are responsible for recovery. We explore reasons for why this is and why this approach may be beneficial.

Crit Care Med. 2011 Oct 27;
Louis G, Megarbane B, Lavoué S, Lassalle V, Argaud L, Poussel JF, Georges H, Bollaert PE

OBJECTIVE:: Very few data are available for critically ill patients with central or extrapontine myelinolysis and according to available evidence, the prognosis seems to be poor. We aimed to describe the baseline characteristics, the management, the long-term prognosis, and the prognostic factors in central or extrapontine myelinolysis. DESIGN:: Retrospective observational study considering modified Rankin Scale score >3 or death as an unfavorable outcome. SETTING:: Forty-six French intensive care units. PATIENTS:: Thirty-six patients with central or extrapontine myelinolysis treated in 2000-2010. INTERVENTIONS:: None. MEASUREMENTS AND MAIN RESULTS:: At baseline, 31 (86%) patients were alcoholics and 33 (92%) presented with hyponatremia. Mechanical ventilation was required in 32 (89%) patients. At 1-yr follow-up, 11 (31%) patients have died, whereas 14 (56%) survivors have returned to a Rankin score ≤1. Life-supporting therapies were withheld in 11 (31%) patients. Severe cerebral motor disability was the most frequently cited reason. However, five of them were still alive at 1 yr with Rankin score ≤1 for four of them. We found no statistical difference between the 18 (50%) patients with a favorable outcome and the 18 (50%) patients with an unfavorable outcome with regard to severity of illness, suggesting that recovery is possible and unpredictable on the basis of clinical presentation. Chronic alcoholism was less frequent in patients with a favorable outcome as compared with patient with an unfavorable outcome (13 [72%] vs. 18 [100%], p = .04). CONCLUSIONS:: The prognosis of critically ill patients with central or extrapontine myelinolysis is better than thus far thought despite initial severe clinical manifestations. Regarding the high rate of decisions to withhold life-supporting therapies, the probability of a favorable outcome might be underestimated by intensivists.

Am J Addict. 2011 Nov-Dec; 20(6): 525-9
Kolla BP, Schneekloth TD, Biernacka JM, Frye MA, Mansukhani MP, Hall-Flavin DK, Karpyak VM, Loukianova LL, Lesnick TG, Mrazek D

Trazodone is one of the most commonly prescribed hypnotic medications in patients with sleep disturbances in alcohol recovery. A recent study concluded that treating insomnia with trazodone in patients with alcohol dependence might impede improvements in alcohol consumption and lead to increased drinking when trazodone is stopped. We set out to investigate the relationship between trazodone use during alcoholism treatment and relapse rates in patients who were discharged from a residential alcohol treatment program. We retrospectively reviewed records of patients with a diagnosis of alcohol dependence in a residential addiction treatment center from 2005 to 2008 and analyzed the association of trazodone use at discharge and alcohol relapse at 6 months. We also assessed the association between trazodone use and relapse at 6 months adjusting for sex, drug dependence, nonsubstance use Axis I psychiatric diagnoses, patient self-report of difficulties with sleep, and anti-dipsotropic medication use at discharge and evaluated pair-wise interactions of trazodone use with the adjustment variables. Of 283 patients eligible for inclusion, 85 (30%) were taking trazodone at discharge. Older age, self-reported sleep problems, and having a nonsubstance use Axis I psychiatric diagnosis were associated with trazodone use. After discharge, 170 (60%) subjects responded to follow-up efforts. Neither intent to treat nor responder only analysis revealed any association between trazodone use and relapse. Our retrospective study of a complex patient population discharged from a residential treatment setting did not find an association between trazodone use at discharge and relapse rates at 6 months.

Br J Pharmacol. 2011 Sep 28;
Wu Y, Lousberg EL, Moldenhauer LM, Hayball JD, Coller JK, Rice KC, Watkins LR, Somogyi AA, Hutchinson MR

BACKGROUND AND PURPOSE  Emerging evidence implicates a role for toll-like receptor 4 (TLR4) in the central nervous system effects of alcohol. The current study aimed to determine whether TLR4-MyD88-dependent signalling was involved in the acute behavioural actions of alcohol and if alcohol could activate TLR4-downstream MAPK and NFκB pathways. EXPERIMENTAL APPROACH  The TLR4 pathway was evaluated using the TLR4 antagonist (+)-naloxone (µ-opioid receptor-inactive isomer) and mice with null mutations in the TLR4 and MyD88 genes. Sedation and motor impairment induced by a single dose of alcohol were assessed by loss of righting reflex (LORR) and rotarod tests, separately. The phosphorylation of JNK, ERK, and p38, and levels of IκBα were measured to determine the effects of acute alcohol exposure on MAPK and NFκB signalling. KEY RESULTS  After a single dose of alcohol, both pharmacological inhibition of TLR4 signalling with (+)-naloxone and genetic deficiency of TLR4 or MyD88 significantly (p < 0.0001) reduced the duration of LORR by 45-78%, and significantly (p < 0.05) decreased motor impairment recovery time to 62-88% of controls. These behavioural actions were not due to changes in the peripheral or central alcohol pharmacokinetics. IκBα levels responded to alcohol by 30 min in mixed hippocampal cell samples, from wild-type mice, but not in cells from TLR4 or MyD88 deficient mice. CONCLUSIONS AND IMPLICATIONS  These data provide new evidence that TLR4-MyD88 signalling is involved in the acute behavioural actions of alcohol in mice.

Alcohol Clin Exp Res. 2011 Sep 26;
Litten RZ, Fertig JB, Falk DE, Ryan ML, Mattson ME, Collins JF, Murtaugh C, Ciraulo D, Green AI, Johnson B, Pettinati H, Swift R, Afshar M, Brunette MF, Tiouririne NA, Kampman K, Stout R,

Background:  Despite advances in developing medications to treat alcohol dependence, few such medications have been approved by the Food and Drug Administration. Identified molecular targets are encouraging and can lead to the development and testing of new compounds. Atypical antipsychotic medications have been explored with varying results. Prior research suggests that the antipsychotic quetiapine may be beneficial in an alcohol-dependent population of very heavy drinkers. Methods:  In this double-blind, placebo-controlled trial, 224 alcohol-dependent patients who reported very heavy drinking were recruited across 5 clinical sites. Patients received either quetiapine or placebo and Medical Management behavioral intervention. Patients were stratified on gender, clinical site, and reduction in drinking prior to randomization. Results:  No differences between the quetiapine and placebo groups were detected in the primary outcome, percentage heavy-drinking days, or other drinking outcomes. Quetiapine significantly reduced depressive symptoms and improved sleep but had no effect on other nondrinking outcomes. Results from a subgroup analysis suggest that patients who reduced their drinking prior to randomization had significantly better drinking outcomes during the maintenance phase (p 

Am J Med Sci. 2011 Sep 20;
Mufson MA, Hao JB, Stanek RJ, Norton NB

INTRODUCTION:: Invasive Streptococcus pneumoniae (pneumococcal) disease (IPD) carries a high risk of death, approximately 15% to 20% in pneumonia, 40% in meningitis and 10% to 15% in septicemia. The occurrence of 2 or more IPD (recurrent) in the same individual is uncommon. The authors investigated the clinical features of patients with recurrent IPD to assess whether they possessed risk factors that increased their likelihood of recurrent IPD. METHODS:: Between 1983 and 2010, the authors identified 27 patients with recurrent IPD during inpatient surveillance of 889 patients with IPD in Huntington, WV, by recovery of pneumococci from otherwise sterile sites. Serotype/serogroup (ST/SG) was determined by capsular swelling and the penicillin MIC by E-strip. Clinical data were abstracted from hospital charts. RESULTS:: Sixteen (59%) of 27 patients were 65 years and older at first IPD, males predominated (67%), two-thirds had pneumonia and 21 (78%) had the same clinical diagnosis at both IPD. Four (80%) of 5 patients with the same ST experienced their second IPD 1 to 6 months apart, unlike most patients with discordant ST/SGs (P = 0.047). Eighty-four percent of ST/SGs were included in the 23-valent pneumococcal vaccine and occurred as often during the first and second IPD. Twenty (77%) of 26 adults suffered from comorbid diseases placing them at high risk of IPD, including multiple myeloma, HIV/AIDS, neoplasia of hematological origin and sickle cell disease. CONCLUSIONS:: Recurrent IPD occurred uncommonly. Comorbid conditions including multiple myeloma and immunosuppressive/immunodeficient conditions, chronic alcoholism and splenectomy represented unique risk factors for recurrent IPD but did not predict recurrences.

Rinsho Shinkeigaku. 2010 Nov; 50(11): 855-7
Miyajima H, Kono S

Wernicke's encephalopathy is a syndrome characterized by ataxia, ophthalmoplegia, and confusion with thiamine deficiency. We reported on two Japanese brothers with a newly discovered recessively inherited syndrome similar to Wernicke's encephalopathy that developed in the second decade of life; this syndrome was manifested clinically as thiamine-responsive diplopia, ataxia and confusion without serum thiamine deficiency. The patients had complex partial seizure. The administration of high-dose thiamine improved these symptoms. MRI of the brain showed high-intensity signals in the bilateral medial thalamus and periaqueductal region on fluid-attenuated inversion recovery images; these signals were characteristic of findings in Wernicke's encephalopathy. There was no history of chronic alcoholism. The clinical and images features resembling Wernicke's encephalopathy in these patients suggested that the syndrome was caused by a genetic disorder of thiamine metabolism. Genomic analysis of SLC10A3 encoding human thiamine transporter 2 revealed that the patients were compound heterozygotes for the K44E and E320Q mutations. Gene-expression analyses of mammalian culture cells showed that intracellular thiamine uptake activities were decreased significantly. High expression of SLC19A3 RNA in the thalamus may explain the selective thalamic lesions on MRI. The identification of this syndrome proves insight into the thiamine metabolism associated with Wernicke's encephalopathy in humans.

Alcohol Clin Exp Res. 2012 Feb; 36(2): 351-60
Fox HC, Anderson GM, Tuit K, Hansen J, Kimmerling A, Siedlarz KM, Morgan PT, Sinha R

Background:  Stress, alcohol cues, and dysregulated stress responses increase alcohol craving and relapse susceptibility, but few pharmacologic agents are known to decrease stress- and cue-induced alcohol craving and associated stress dysregulation in humans. Here we report findings from a preliminary efficacy study of the alpha-1 receptor antagonist, prazosin, in modulating these relapse-relevant factors in alcohol-dependent individuals. Methods:  Seventeen early abstinent, treatment-seeking alcohol-dependent individuals (12 men and 5 women) were randomly assigned to receive either placebo or 16 mg daily prazosin in a double-blind, placebo-controlled manner over 4 weeks. During week 4, all patients participated in a 3-day laboratory experiment involving 5-minute guided imagery exposure to stress, alcohol cue, and neutral-relaxing/control conditions, 1 exposure per day, on consecutive days in a random, counterbalanced order. Alcohol craving, anxiety, negative emotion, cardiovascular measures, and plasma hypothalamic-pituitary-adrenal (HPA; cortisol, adenocorticotropic hormone) were assessed repeatedly in each session. Results:  The prazosin group (n = 9) versus the placebo group (n = 8) showed significantly lower alcohol craving, anxiety, and negative emotion following stress exposure. The placebo group also showed significantly increased stress- and cue-induced alcohol craving, anxiety, negative emotion, and blood pressure (BP), as well as a blunted HPA response relative to the neutral condition, while the prazosin group showed no such increases in craving, anxiety, negative emotion, and BP, and no blunted HPA response to stress and alcohol cue exposure. Conclusions:  Prazosin appears efficacious in decreasing stress- and cue-induced alcohol craving and may normalize the stress dysregulation associated with early recovery from alcoholism. Further research to assess the efficacy of prazosin in reducing alcohol craving and stress-related relapse risk is warranted.

Alcohol Clin Exp Res. 2011 Dec; 35(12): 2184-92
Smith S, Fein G

Disturbed gait and balance are among the most consistent and salient sequelae of chronic alcoholism. Results of small sample longitudinal investigations have provided evidence that partial recovery of gait and balance functions in alcoholics may be achieved with abstinence. However, abstinence durations reported have been limited, and their power and generalizability have suffered from small sample sizes.In this study, we employed a cross-sectional approach to assess gait and balance functions in short-term (6 to 15 weeks) abstinent alcoholics (STAA; n = 70) and long-term (minimum 18 months, mean = 7.38 years) abstinent alcoholics (LTAA; n = 82). STAA and LTAA did not differ with respect to lifetime alcohol consumption, family drinking density, or years of education. In addition, we examined the effects of gender and alcohol use variables.Our main findings were: (i) persistent disturbed gait and balance in STAA and disturbed standing balance in LTAA; (ii) overall less impaired performance of LTAA compared with STAA on gait and balance measures; and (iii) worse performance of STAA (but not LTAA) women, compared with men, on standing balance without visual control.Our results suggest that alcoholics' gait and balance can continue to recover with long abstinence from alcohol, but that deficits persist, especially in eyes-closed standing balance. In addition, our results are consistent with more severe alcohol-induced ataxia in women than in men but suggest that with extended abstinence, women recover gait and balance function to a level comparable with men.

Addiction. 2011 Oct; 106(10): 1770-1
Scott C, Dennis M

Psychiatry Res. 2011 Nov 30; 194(2): 198-204
Mon A, Delucchi K, Durazzo TC, Gazdzinski S, Meyerhoff DJ

We propose a mathematical formula that predicts the trajectory of the recovery from lobar gray and white matter volume deficits in individuals with sustained abstinence from alcohol. The formula was validated by using MRI-measured volumetric data from 16 alcohol dependent individuals who had brain scans at three time points during abstinence from alcohol. Using the measured volumetric data of each individual from the first two time points, we estimated the individual's gray and white matter volume of the frontal, parietal and temporal lobes for the third time point using the formula. Similarly, using the measured data for the second and third time points, we estimated the first time point data for each individual. The data predicted from the formula were very similar to the experimentally measured data for all lobes and for both gray and white matter. The intra-class correlation coefficients between the measured data and the data estimated from the formula were >0.95 for almost all the tissues. The formula may also be applicable in other neuroimaging studies of tissue volume changes such as white matter myelination during brain development and white matter demyelination or brain volume loss in neurodegenerative diseases, such as Alzheimer's disease.

JAMA. 2011 Aug 3; 306(5): 532-40
Mosqueda L, Dong X

Elder mistreatment encompasses a range of behaviors including emotional, financial, physical, and sexual abuse, neglect by other individuals, and self-neglect. This article discusses the range of elder mistreatment in community-living older adults, associated factors, and consequences. Although self-neglect is not considered a type of abuse in many research definitions, it is the most commonly reported form of elder mistreatment and is associated with increased morbidity and mortality. The case on which this article is based describes a 70-year-old woman who neglects herself and dies despite multiple contacts with the medical community. Despite significant gaps in research, enough is known to guide clinical practice. This article presents the practical approaches a health care professional can take when a reasonable suspicion of elder mistreatment arises. Public health and interdisciplinary team approaches are needed to manage what is becoming an increasing problem as the number of older adults around the world increases.

Alcohol Clin Exp Res. 2012 Jan; 36(1): 24-34
Krishnan HR, Al-Hasan YM, Pohl JB, Ghezzi A, Atkinson NS

Background:  A prevailing hypothesis is that the set of genes that underlie the endophenotypes of alcoholism overlap with those responsible for the addicted state. Functional ethanol tolerance, an endophenotype of alcoholism, is defined as a reduced response to ethanol caused by prior ethanol exposure. The neuronal origins of functional rapid tolerance are thought to be a homeostatic response of the nervous system that counters the effects of the drug. Synaptic proteins that regulate neuronal activity are an important evolutionarily conserved target of ethanol. Methods:  We used mutant analysis in Drosophila to identify synaptic proteins that are important for the acquisition of rapid tolerance to sedation with ethanol. Tolerance was assayed by sedating flies with ethanol vapor and comparing the recovery time of flies after their first sedation and their second sedation. Temperature-sensitive paralytic mutants that alter key facets of synaptic neurotransmission, such as the propagation of action potentials, synaptic vesicle fusion, exocytosis, and endocytosis, were tested for the ability to acquire functional tolerance at both the permissive and restrictive temperatures. Results:  The shibire gene encodes Drosophila Dynamin. We tested 2 temperature-sensitive alleles of the gene. The shi(ts1) allele blocked tolerance at both the permissive and restrictive temperatures, while shi(ts2) blocked only at the restrictive temperature. Using the temperature-sensitive property of shi(ts2) , we showed that Dynamin function is required concomitant with exposure to ethanol. A temperature-sensitive allele of the Syntaxin 1A gene, Syx1A(3-69) , also blocked the acquisition of ethanol tolerance. Conclusions:  We have shown that shibire and Syntaxin 1A are required for the acquisition of rapid functional tolerance to ethanol. Furthermore, the shibire gene product, Dynamin, appears to be required for an immediate early response to ethanol that triggers a cellular response leading to rapid functional tolerance.

Am J Drug Alcohol Abuse. 2011 Nov; 37(6): 487-90
Karam-Hage M, Strobbe S, Robinson JD, Brower KJ

We conducted a double-blind pilot study involving 11 alcohol- and nicotine-dependent patients randomized to receive either bupropion or placebo. Four of six patients on bupropion and one of five patients on placebo were abstinent from smoking at the end of medication phase. Those in the bupropion group reported significantly less craving (p < .02) and less exposure to cigarette smoke over time (expired carbon monoxide; p < .01). There were no serious adverse events and no main effects of medication group on either per subject or total number of adverse events. All those who completed treatment remained abstinent from alcohol.

Curr Top Behav Neurosci. 2011 Jul 17;
Sinha R

It is well known that alcoholism is a chronic relapsing illness. While stress significantly impacts alcoholism risk, there is also evidence that increasing levels of alcohol use affect peripheral and central stress and reward pathways thereby setting up a reciprocal relationship among the effects of alcohol consumption of the development, course of and recovery from alcoholism. This chapter reviews our efforts in assessing the integrity of stress pathways in alcoholism by examining whether altered responses of the stress pathways play a role in relapse risk. Using validated human laboratory procedures to model two of the most common situations that contribute to relapse risk, we review how such models in the laboratory can predict subsequent alcohol relapse. Empirical findings from human laboratory and brain imaging studies are reviewed to show that specific stress-related dysregulation accompanies the alcohol craving state in alcohol-dependent individuals, and such dysregulation along with increases in alcohol seeking are predictive of increased alcohol relapse risk. Finally, the significant implications of these findings for the development of novel treatment interventions that target stress processes and alcohol craving to improve alcoholism relapse outcomes are discussed.

Neurologist. 2011 Jul; 17(4): 213-7
Lee SH, Kim SS, Kim SH, Lee SY

Marchiafava-Bignami disease (MBD) is defined pathologically as callosal degeneration associated with chronic alcoholism. We report a patient with MBD with acute lesions confined in the precentral cortex and splenium. Various magnetic resonance imaging (MRI) modalities were performed sequentially to elucidate the pathophysiology.A 52-year-old man with chronic alcoholism developed acute confusion and dysarthria. He improved incompletely with nutritional supplementation. Diffusion-weighted imaging MRI disclosed the presence of reversible lesions with low apparent diffusion coefficient values in the precentral cortex and splenium. Perfusion-weighted imaging revealed that the cerebral blood volume and flow decreased and subsequently increased, and the mean transit time and time to peak were persistently prolonged. On magnetic resonance spectroscopy, choline was initially normal and became elevated during the recovery period, whereas N-acetylaspartate was low initially and after the resolution of the lesion on conventional MRI.The precentral cortex and splenium are the most vulnerable areas in acute MBD. The lesions have reversible restricted diffusivity and hypoperfusion. The magnetic resonance spectroscopy findings correlate well with the clinical status.

Alcohol Clin Exp Res. 2012 Feb 6;
Dawson DA, Goldstein RB, Ruan WJ, Grant BF

BACKGROUND: Correlates of recovery from alcohol dependence have been identified through a variety of study designs characterized by different strengths and limitations. The goal of this study was to compare correlates of recovery based on a 3-year prospective design with those based on cross-sectional analyses of data from the same source. METHODS: Data from the 2001 to 2002 Wave 1 and 2004 to 2005 Wave 2 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) were used to examine baseline characteristics associated with Wave 2 recovery from alcohol dependence, among those who classified with past-year DSM-IV alcohol dependence at Wave 1 (n = 1,172). RESULTS: Abstinent recovery was significantly associated with Black/Asian/Hispanic race/ethnicity, children

Addict Biol. 2012 Jan 20;
Stavro K, Pelletier J, Potvin S

The cognitive repercussions of alcohol dependence are well documented. However, the literature remains somewhat ambiguous with respect to which distinct cognitive functions are more susceptible to impairment in alcoholism and to how duration of abstinence affects cognitive recovery. Some theories claim alcohol negatively affects specific cognitive functions, while others assert that deficits are more diffuse in nature. This is the first meta-analysis to examine cognition in alcohol abuse/dependence and the duration of abstinence necessary to achieve cognitive recovery. A literature search yielded 62 studies that assessed cognitive dysfunction among alcoholics. Effect size estimates were calculated using the Comprehensive Meta-Analysis V2, for the following 12 cognitive domains: intelligence quotient, verbal fluency/language, speed of processing, working memory, attention, problem solving/executive functions, inhibition/impulsivity, verbal learning, verbal memory, visual learning, visual memory and visuospatial abilities. Within these 12 domains, three effect size estimates were calculated based on abstinence duration. The three groups were partitioned into short- (1 year) term abstinence. Findings revealed moderate impairment across 11 cognitive domains during short-term abstinence, with moderate impairment across 10 domains during intermediate term abstinence. Small effect size estimates were found for long-term abstinence. These results suggest significant impairment across multiple cognitive functions remains stable during the first year of abstinence from alcohol. Generally, dysfunction abates by 1 year of sobriety. These findings support the diffuse brain hypothesis and suggest that cognitive dysfunction may linger for up to an average of 1 year post-detoxification from alcohol.

Nihon Arukoru Yakubutsu Igakkai Zasshi. 2011 Oct; 46(5): 454-68; discussion 469
Komoto Y, Hashimoto N, Ikegami Y

It is important to evaluate and classify individual features of patients to select an appropriate treatment for alcoholism. In this study, we classified alcoholism types according to strength/weakness of autism features and investigated how these features were associated with onset, course, and especially continuation of abstinence.The subjects were 102 man outpatients diagnosed with alcoholism. The investigations were made on 3 areas: 1. Basic background including age, family and occupational information, 2. Medical variables including the number of years since the first visit, with/without juvenile onset, psychiatric complications, hospital admission history, self-help group participation, and the longest abstinence period, and 3. Autism-spectrum Quotient (AQ) scores. The AQ test is a self-administered test of autism features on a maximum scale of 50 points, based on the concept of "autism spectrum".The mean (standard deviation) of AQ scores of 102 subjects was 22.6 (7.18) with normal distribution. 78 subjects who had been followed-up for more than 2 years were classified into the low score (0-15) group of 11 subjects, the average score (16-29) group of 51 subjects, and the high score (30-50) group of 16 subjects, according to their AQ scores. No significant difference was observed in terms of patients' background and medical variables, but the number of subjects with stable abstinence (more than 2 years) was higher in the high score group compared to the average and low score groups (p = 0.0208).At least for men, it was presumed that continuation of alcohol abstinence was more difficult in the average score group (general type) and the low score group (over-empathy type) compared to the high score group (autism type) (odds ratio: 5.76); treatment approaches should be managed appropriately for these 3 types. It was also shown that the AQ test was a useful indicator for abstinence prognosis.

Curr Drug Abuse Rev. 2011 Dec; 4(4): 250-60
Haber JR, Koenig LB, Jacob T

A review of the literature on the relationships between alcoholism, personality, and religion identified patterns that may help explain the inverse association between alcoholism and religion/spirituality (R/S). Personality plays a central role in two etiological models of alcoholism. The personality traits of high behavioral undercontrol (low Agreeableness and low Conscientiousness) and high negative affect (high Neuroticism) are both significantly related to higher alcohol use. Religiosity is also correlated with these traits, but in the opposite direction (e.g., with low behavioral undercontrol and low negative affect). Thus, the personality profiles associated with alcoholism and religion are the inverse of one another. In addition, evidence suggests that R/S moderates genetic variation on both Neuroticism and Disinhibition (part of behavioral undercontrol). Implications are discussed in terms of competing explanatory models: a basic research model which argues for genetically-determined stability in personality and alcoholism risk, and a clinical treatment model which argues for the primacy of environmental interventions in treatment and the possibility of personality change as a pathway to recovery.

Am J Addict. 2011 Nov-Dec; 20(6): 525-9
Kolla BP, Schneekloth TD, Biernacka JM, Frye MA, Mansukhani MP, Hall-Flavin DK, Karpyak VM, Loukianova LL, Lesnick TG, Mrazek D

Trazodone is one of the most commonly prescribed hypnotic medications in patients with sleep disturbances in alcohol recovery. A recent study concluded that treating insomnia with trazodone in patients with alcohol dependence might impede improvements in alcohol consumption and lead to increased drinking when trazodone is stopped. We set out to investigate the relationship between trazodone use during alcoholism treatment and relapse rates in patients who were discharged from a residential alcohol treatment program. We retrospectively reviewed records of patients with a diagnosis of alcohol dependence in a residential addiction treatment center from 2005 to 2008 and analyzed the association of trazodone use at discharge and alcohol relapse at 6 months. We also assessed the association between trazodone use and relapse at 6 months adjusting for sex, drug dependence, nonsubstance use Axis I psychiatric diagnoses, patient self-report of difficulties with sleep, and anti-dipsotropic medication use at discharge and evaluated pair-wise interactions of trazodone use with the adjustment variables. Of 283 patients eligible for inclusion, 85 (30%) were taking trazodone at discharge. Older age, self-reported sleep problems, and having a nonsubstance use Axis I psychiatric diagnosis were associated with trazodone use. After discharge, 170 (60%) subjects responded to follow-up efforts. Neither intent to treat nor responder only analysis revealed any association between trazodone use and relapse. Our retrospective study of a complex patient population discharged from a residential treatment setting did not find an association between trazodone use at discharge and relapse rates at 6 months.

Br J Pharmacol. 2011 Sep 28;
Wu Y, Lousberg EL, Moldenhauer LM, Hayball JD, Coller JK, Rice KC, Watkins LR, Somogyi AA, Hutchinson MR

BACKGROUND AND PURPOSE  Emerging evidence implicates a role for toll-like receptor 4 (TLR4) in the central nervous system effects of alcohol. The current study aimed to determine whether TLR4-MyD88-dependent signalling was involved in the acute behavioural actions of alcohol and if alcohol could activate TLR4-downstream MAPK and NFκB pathways. EXPERIMENTAL APPROACH  The TLR4 pathway was evaluated using the TLR4 antagonist (+)-naloxone (µ-opioid receptor-inactive isomer) and mice with null mutations in the TLR4 and MyD88 genes. Sedation and motor impairment induced by a single dose of alcohol were assessed by loss of righting reflex (LORR) and rotarod tests, separately. The phosphorylation of JNK, ERK, and p38, and levels of IκBα were measured to determine the effects of acute alcohol exposure on MAPK and NFκB signalling. KEY RESULTS  After a single dose of alcohol, both pharmacological inhibition of TLR4 signalling with (+)-naloxone and genetic deficiency of TLR4 or MyD88 significantly (p < 0.0001) reduced the duration of LORR by 45-78%, and significantly (p < 0.05) decreased motor impairment recovery time to 62-88% of controls. These behavioural actions were not due to changes in the peripheral or central alcohol pharmacokinetics. IκBα levels responded to alcohol by 30 min in mixed hippocampal cell samples, from wild-type mice, but not in cells from TLR4 or MyD88 deficient mice. CONCLUSIONS AND IMPLICATIONS  These data provide new evidence that TLR4-MyD88 signalling is involved in the acute behavioural actions of alcohol in mice.

Alcohol Clin Exp Res. 2011 Sep 26;
Litten RZ, Fertig JB, Falk DE, Ryan ML, Mattson ME, Collins JF, Murtaugh C, Ciraulo D, Green AI, Johnson B, Pettinati H, Swift R, Afshar M, Brunette MF, Tiouririne NA, Kampman K, Stout R,

Background:  Despite advances in developing medications to treat alcohol dependence, few such medications have been approved by the Food and Drug Administration. Identified molecular targets are encouraging and can lead to the development and testing of new compounds. Atypical antipsychotic medications have been explored with varying results. Prior research suggests that the antipsychotic quetiapine may be beneficial in an alcohol-dependent population of very heavy drinkers. Methods:  In this double-blind, placebo-controlled trial, 224 alcohol-dependent patients who reported very heavy drinking were recruited across 5 clinical sites. Patients received either quetiapine or placebo and Medical Management behavioral intervention. Patients were stratified on gender, clinical site, and reduction in drinking prior to randomization. Results:  No differences between the quetiapine and placebo groups were detected in the primary outcome, percentage heavy-drinking days, or other drinking outcomes. Quetiapine significantly reduced depressive symptoms and improved sleep but had no effect on other nondrinking outcomes. Results from a subgroup analysis suggest that patients who reduced their drinking prior to randomization had significantly better drinking outcomes during the maintenance phase (p 

Alcohol Clin Exp Res. 2012 Feb; 36(2): 351-60
Fox HC, Anderson GM, Tuit K, Hansen J, Kimmerling A, Siedlarz KM, Morgan PT, Sinha R

Background:  Stress, alcohol cues, and dysregulated stress responses increase alcohol craving and relapse susceptibility, but few pharmacologic agents are known to decrease stress- and cue-induced alcohol craving and associated stress dysregulation in humans. Here we report findings from a preliminary efficacy study of the alpha-1 receptor antagonist, prazosin, in modulating these relapse-relevant factors in alcohol-dependent individuals. Methods:  Seventeen early abstinent, treatment-seeking alcohol-dependent individuals (12 men and 5 women) were randomly assigned to receive either placebo or 16 mg daily prazosin in a double-blind, placebo-controlled manner over 4 weeks. During week 4, all patients participated in a 3-day laboratory experiment involving 5-minute guided imagery exposure to stress, alcohol cue, and neutral-relaxing/control conditions, 1 exposure per day, on consecutive days in a random, counterbalanced order. Alcohol craving, anxiety, negative emotion, cardiovascular measures, and plasma hypothalamic-pituitary-adrenal (HPA; cortisol, adenocorticotropic hormone) were assessed repeatedly in each session. Results:  The prazosin group (n = 9) versus the placebo group (n = 8) showed significantly lower alcohol craving, anxiety, and negative emotion following stress exposure. The placebo group also showed significantly increased stress- and cue-induced alcohol craving, anxiety, negative emotion, and blood pressure (BP), as well as a blunted HPA response relative to the neutral condition, while the prazosin group showed no such increases in craving, anxiety, negative emotion, and BP, and no blunted HPA response to stress and alcohol cue exposure. Conclusions:  Prazosin appears efficacious in decreasing stress- and cue-induced alcohol craving and may normalize the stress dysregulation associated with early recovery from alcoholism. Further research to assess the efficacy of prazosin in reducing alcohol craving and stress-related relapse risk is warranted.

Alcohol Clin Exp Res. 2011 Dec; 35(12): 2184-92
Smith S, Fein G

Disturbed gait and balance are among the most consistent and salient sequelae of chronic alcoholism. Results of small sample longitudinal investigations have provided evidence that partial recovery of gait and balance functions in alcoholics may be achieved with abstinence. However, abstinence durations reported have been limited, and their power and generalizability have suffered from small sample sizes.In this study, we employed a cross-sectional approach to assess gait and balance functions in short-term (6 to 15 weeks) abstinent alcoholics (STAA; n = 70) and long-term (minimum 18 months, mean = 7.38 years) abstinent alcoholics (LTAA; n = 82). STAA and LTAA did not differ with respect to lifetime alcohol consumption, family drinking density, or years of education. In addition, we examined the effects of gender and alcohol use variables.Our main findings were: (i) persistent disturbed gait and balance in STAA and disturbed standing balance in LTAA; (ii) overall less impaired performance of LTAA compared with STAA on gait and balance measures; and (iii) worse performance of STAA (but not LTAA) women, compared with men, on standing balance without visual control.Our results suggest that alcoholics' gait and balance can continue to recover with long abstinence from alcohol, but that deficits persist, especially in eyes-closed standing balance. In addition, our results are consistent with more severe alcohol-induced ataxia in women than in men but suggest that with extended abstinence, women recover gait and balance function to a level comparable with men.

Psychiatry Res. 2011 Nov 30; 194(2): 198-204
Mon A, Delucchi K, Durazzo TC, Gazdzinski S, Meyerhoff DJ

We propose a mathematical formula that predicts the trajectory of the recovery from lobar gray and white matter volume deficits in individuals with sustained abstinence from alcohol. The formula was validated by using MRI-measured volumetric data from 16 alcohol dependent individuals who had brain scans at three time points during abstinence from alcohol. Using the measured volumetric data of each individual from the first two time points, we estimated the individual's gray and white matter volume of the frontal, parietal and temporal lobes for the third time point using the formula. Similarly, using the measured data for the second and third time points, we estimated the first time point data for each individual. The data predicted from the formula were very similar to the experimentally measured data for all lobes and for both gray and white matter. The intra-class correlation coefficients between the measured data and the data estimated from the formula were >0.95 for almost all the tissues. The formula may also be applicable in other neuroimaging studies of tissue volume changes such as white matter myelination during brain development and white matter demyelination or brain volume loss in neurodegenerative diseases, such as Alzheimer's disease.

Alcohol Clin Exp Res. 2012 Jan; 36(1): 24-34
Krishnan HR, Al-Hasan YM, Pohl JB, Ghezzi A, Atkinson NS

Background:  A prevailing hypothesis is that the set of genes that underlie the endophenotypes of alcoholism overlap with those responsible for the addicted state. Functional ethanol tolerance, an endophenotype of alcoholism, is defined as a reduced response to ethanol caused by prior ethanol exposure. The neuronal origins of functional rapid tolerance are thought to be a homeostatic response of the nervous system that counters the effects of the drug. Synaptic proteins that regulate neuronal activity are an important evolutionarily conserved target of ethanol. Methods:  We used mutant analysis in Drosophila to identify synaptic proteins that are important for the acquisition of rapid tolerance to sedation with ethanol. Tolerance was assayed by sedating flies with ethanol vapor and comparing the recovery time of flies after their first sedation and their second sedation. Temperature-sensitive paralytic mutants that alter key facets of synaptic neurotransmission, such as the propagation of action potentials, synaptic vesicle fusion, exocytosis, and endocytosis, were tested for the ability to acquire functional tolerance at both the permissive and restrictive temperatures. Results:  The shibire gene encodes Drosophila Dynamin. We tested 2 temperature-sensitive alleles of the gene. The shi(ts1) allele blocked tolerance at both the permissive and restrictive temperatures, while shi(ts2) blocked only at the restrictive temperature. Using the temperature-sensitive property of shi(ts2) , we showed that Dynamin function is required concomitant with exposure to ethanol. A temperature-sensitive allele of the Syntaxin 1A gene, Syx1A(3-69) , also blocked the acquisition of ethanol tolerance. Conclusions:  We have shown that shibire and Syntaxin 1A are required for the acquisition of rapid functional tolerance to ethanol. Furthermore, the shibire gene product, Dynamin, appears to be required for an immediate early response to ethanol that triggers a cellular response leading to rapid functional tolerance.

Am J Drug Alcohol Abuse. 2011 Nov; 37(6): 487-90
Karam-Hage M, Strobbe S, Robinson JD, Brower KJ

We conducted a double-blind pilot study involving 11 alcohol- and nicotine-dependent patients randomized to receive either bupropion or placebo. Four of six patients on bupropion and one of five patients on placebo were abstinent from smoking at the end of medication phase. Those in the bupropion group reported significantly less craving (p < .02) and less exposure to cigarette smoke over time (expired carbon monoxide; p < .01). There were no serious adverse events and no main effects of medication group on either per subject or total number of adverse events. All those who completed treatment remained abstinent from alcohol.

Curr Top Behav Neurosci. 2011 Jul 17;
Sinha R

It is well known that alcoholism is a chronic relapsing illness. While stress significantly impacts alcoholism risk, there is also evidence that increasing levels of alcohol use affect peripheral and central stress and reward pathways thereby setting up a reciprocal relationship among the effects of alcohol consumption of the development, course of and recovery from alcoholism. This chapter reviews our efforts in assessing the integrity of stress pathways in alcoholism by examining whether altered responses of the stress pathways play a role in relapse risk. Using validated human laboratory procedures to model two of the most common situations that contribute to relapse risk, we review how such models in the laboratory can predict subsequent alcohol relapse. Empirical findings from human laboratory and brain imaging studies are reviewed to show that specific stress-related dysregulation accompanies the alcohol craving state in alcohol-dependent individuals, and such dysregulation along with increases in alcohol seeking are predictive of increased alcohol relapse risk. Finally, the significant implications of these findings for the development of novel treatment interventions that target stress processes and alcohol craving to improve alcoholism relapse outcomes are discussed.

J Stud Alcohol Drugs. 2011 Jul; 72(4): 660-8
Robinson EA, Krentzman AR, Webb JR, Brower KJ

Although spiritual change is hypothesized to contribute to recovery from alcohol dependence, few studies have used prospective data to investigate this hypothesis. Prior studies have also been limited to treatment-seeking and Alcoholics Anonymous (AA) samples. This study included alcohol-dependent individuals, both in treatment and not, to investigate the effect of spiritual and religious (SR) change on subsequent drinking outcomes, independent of AA involvement.Alcoholics (N = 364) were recruited for a panel study from two abstinence-based treatment centers, a moderation drinking program, and untreated individuals from the local community. Quantitative measures of SR change between baseline and 6 months were used to predict 9-month drinking outcomes, controlling for baseline drinking and AA involvement.Significant 6-month changes in 8 of 12 SR measures were found, which included private SR practices, beliefs, daily spiritual experiences, three measures of forgiveness, negative religious coping, and purpose in life. Increases in private SR practices and forgiveness of self were the strongest predictors of improvements in drinking outcomes. Changes in daily spiritual experiences, purpose in life, a general measure of forgiveness, and negative religious coping also predicted favorable drinking outcomes.SR change predicted good drinking outcomes in alcoholics, even when controlling for AA involvement. SR variables, broadly defined, deserve attention in fostering change even among those who do not affiliate with AA or religious institutions. Last, future research should include SR variables, particularly various types of forgiveness, given the strong effects found for forgiveness of self.

Adicciones. 2011; 23(2): 157-64
Guardia-Serecigni J, Estorch M, Surkov S, del Valle Camacho M, García-Ribas G

The Multidimensional Alcohol Craving Scale (MACS) and Single Photon Emission Computerized Tomography (SPECT) with (123)I-iodobenzamide ((123)I-IBZM) can be useful tools for assessing relapse risk in early recovery from alcohol-dependency. The aim of this study was to assess possible relationships between MACS score, (123)I-IBZM binding and time to first heavy drinking day (TFHD) after detoxification treatment.Nineteen alcohol-dependent in-patients were evaluated by MACS scale and an 123I-IBZM-SPECT, performed following alcohol detoxification treatment. At discharge, participants were advised to take naltrexone 50 mg/day for relapse prevention. TFHD was assessed over a 12-week follow up.The MACS score at the beginning of the detoxification process and naltrexone treatment after detoxification were independent predictive factors for TFHD.The MACS scale is a better predictor of TFHD than IBZM binding. It is simple, non-invasive and inexpensive and appears to be a useful instrument both for clinical practice and for research.

Liver Transpl. 2011 Jul; 17(7): 751-9
Lucey MR

Although alcoholic liver disease (ALD) is one of the most common indications for liver transplantation (LT), there are still unresolved controversies about the goals of treatment, the referral, evaluation, and selection of patients with ALD for LT, and their care after LT. It is uncertain whether there is a large unmet need for LT among patients with ALD because of the unmeasured effects of recent drinking, relapse, and recovery with abstinence in this population. A careful assessment of the extrahepatic effects of alcohol-related end-organ damage is needed for ALD patients who are referred for an LT evaluation. Although there clearly is a relationship between the length of sobriety and future abstinence, the present methods for predicting future drinking are inexact. The survival of ALD patients after LT is as good as the survival of non-ALD patients, although patients with coincident ALD and hepatitis C virus have higher mortality and morbidity rates. After LT, ALD patients have an increased risk of developing malignancies and cardiovascular disease. These risks appear to be linked to cigarette smoking. Covert drinking occurs both before and after transplantation, and approximately 20% of patients return to harmful drinking after LT. Harmful drinking after LT (instead of slips) causes liver damage and reduces survival. Better therapies for controlling addictions to alcohol and nicotine are needed for ALD patients both before and after LT.

Arch Gen Psychiatry. 2011 Sep; 68(9): 942-52
Sinha R, Fox HC, Hong KI, Hansen J, Tuit K, Kreek MJ

Alcoholism is a chronic, relapsing illness in which stress and alcohol cues contribute significantly to relapse risk. Dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis, increased anxiety, and high alcohol craving have been documented during early alcohol recovery, but their influence on relapse risk has not been well studied.To investigate these responses in treatment-engaged, 1-month-abstinent, recovering alcohol-dependent patients relative to matched controls (study 1) and to assess whether HPA axis function, anxiety, and craving responses are predictive of subsequent alcohol relapse and treatment outcome (study 2).Experimental exposure to stress, alcohol cues, and neutral, relaxing context to provoke alcohol craving, anxiety, and HPA axis responses (corticotropin and cortisol levels and cortisol to corticotropin ratio) and a prospective 90-day follow-up outcome design to assess alcohol relapse and aftercare treatment outcomes.Inpatient treatment in a community mental health center and hospital-based research unit.Treatment-engaged alcohol-dependent individuals and healthy controls.Time to alcohol relapse and to heavy drinking relapse.Significant HPA axis dysregulation, marked by higher basal corticotropin level and lack of stress- and cue-induced corticotropin and cortisol responses, higher anxiety, and greater stress- and cue-induced alcohol craving, was seen in the alcohol-dependent patients vs the control group. Stress- and cue-induced anxiety and stress-induced alcohol craving were associated with fewer days in aftercare alcohol treatment. High provoked alcohol craving to both stress and to cues and greater neutral, relaxed-state cortisol to corticotropin ratio (adrenal sensitivity) were each predictive of shorter time to alcohol relapse.These results identify a significant effect of high adrenal sensitivity, anxiety, and increased stress- and cue-induced alcohol craving on subsequent alcohol relapse and treatment outcomes. Findings suggest that new treatments that decrease adrenal sensitivity, stress- and cue-induced alcohol craving, and anxiety could be beneficial in improving alcohol relapse outcomes.

J Fr Ophtalmol. 2011 Jun; 34(6): 382.e1-3
Trélohan A, Milea D

To report a case of bilateral optic neuropathy, possibly caused by disulfiram.Clinical case report.A 46-year-old patient, treated with disulfiram for the past 4 years for chronic alcoholism, presented with progressive bilateral, painless, severe visual loss, related to optic neuropathy. An extensive work-up did not disclose any other possible cause than a toxic optic neuropathy caused by disulfiram. Discontinuation of disulfiram resulted in rapid, complete visual recovery.Disulfiram can cause toxic optic neuropathy, which can recover after discontinuing the medication, even after a long period of intoxication.

Nat Rev Neurol. 2011 May; 7(5): 284-94
Zahr NM, Kaufman KL, Harper CG

One of the sequelae of chronic alcohol abuse is malnutrition. Importantly, a deficiency in thiamine (vitamin B(1)) can result in the acute, potentially reversible neurological disorder Wernicke encephalopathy (WE). When WE is recognized, thiamine treatment can elicit a rapid clinical recovery. If WE is left untreated, however, patients can develop Korsakoff syndrome (KS), a severe neurological disorder characterized by anterograde amnesia. Alcohol-related brain damage (ARBD) describes the effects of chronic alcohol consumption on human brain structure and function in the absence of more discrete and well-characterized neurological concomitants of alcoholism such as WE and KS. Through knowledge of both the well-described changes in brain structure and function that are evident in alcohol-related disorders such as WE and KS and the clinical outcomes associated with these changes, researchers have begun to gain a better understanding of ARBD. This Review examines ARBD from the perspective of WE and KS, exploring the clinical presentations, postmortem brain pathology, in vivo MRI findings and potential molecular mechanisms associated with these conditions. An awareness of the consequences of chronic alcohol consumption on human behavior and brain structure can enable clinicians to improve detection and treatment of ARBD.

Psychol Addict Behav. 2011 Sep; 25(3): 462-73
Webb JR, Robinson EA, Brower KJ

Religiousness and spirituality are important to most Americans, and evidence suggests that they may contribute to both addiction and recovery. Forgiveness is a specific dimension of religiousness and spirituality that may enhance recovery, but the mechanism(s) through which it operates is unknown. We hypothesized that higher levels of forgiveness would be associated with higher levels of mental health and social support, which, in turn, would be associated with improved alcohol-related outcomes. Baseline and 6-month longitudinal data from a sample of 149 individuals with alcohol use disorders seeking outpatient substance abuse treatment were analyzed through multiple-mediation statistical techniques. While previous research has shown direct associations among forgiveness, alcohol-related outcomes, mental health, and social support, this study found that the direct associations between forgiveness and alcohol-related outcomes were no longer significant when mental health and social support were analyzed as mediator variables. At baseline, for each alcohol-related outcome measured (alcohol-related problems, percent heavy drinking days, percent days abstinent, and drinks per drinking day), mental health individually played a role in the relationship with both forgiveness of self and forgiveness of others, fully mediating or operating through an indirect-only pathway. For alcohol-related problems only, mental health fully mediated the relationship with forgiveness of self at follow-up and operated through an indirect-only pathway with forgiveness of others longitudinally. Social support and feeling forgiven by God were nonsignificant variables at baseline, follow-up, and longitudinally.